Male hypogonadism - testosterone deficiency
Male hypogonadism is the inability of the testicles to produce testosterone, sperm or both. The condition also is known as testosterone deficiency.
As part of their reproductive systems, men have external genital organs called testicles (testes). These two oval-shaped organs reside in a pouch of skin (scrotum) that hangs below the abdomen and behind the penis. In addition to producing the sperm cells that are used in reproduction, the testicles secrete the male hormone testosterone. This hormone plays an important role in the development and maintenance of typical masculine physical characteristics.
During fetal development, testosterone is necessary to form male genital organs. During puberty, testosterone is essential for the development of secondary sexual characteristics, such as facial hair, greater muscle mass and a deeper voice. In adult males, testosterone maintains muscle mass and strength, fat distribution, bone mass, sperm production, sex drive and potency.
Treatment of male hypogonadism depends on the cause and may involve testosterone replacement therapy. Hypogonadism affects approximately one in 500 males.
Signs and symptoms
The effects of male hypogonadism depend primarily on the stage of life at which they occur. They can occur during fetal development, puberty or adulthood. During each of these stages, the signs and symptoms are distinct.
Production of too little hormone by the gonads during early fetal development may impair the growth or functions of the internal and external sex organs. This can cause a condition in which the sex of the child is not clear by external examination at birth (ambiguous genitalia).
The male hormone testosterone plays an important role in the development and maintenance of typical masculine physical characteristics....
Mental and emotional changes also can accompany hypogonadism. As testosterone decreases, some men may experience symptoms similar to those of menopause in women. These may include:
Decreased sex drive
Hypogonadism is the absence of testosterone production by the gonads — the testicles in men and the ovaries in women. These sex organs produce the hormones testosterone and estrogen, which ultimately determine the differences between men and women. The two basic types of male hypogonadism are:
The pituitary gland is located within the brain and controls hormone production....
Male hypogonadism can have many causes. Certain diseases and other malfunctions of the testicles or pituitary gland can cause testosterone deficiency.
Common causes of primary hypogonadism include:
In secondary hypogonadism, the testicles are normal but function improperly due to lack of stimulation by the pituitary hormones. Specific causes include:
Risk factors for hypogonadism include:
Hypogonadism can be hereditary. If any of these risk factors are in your family health history, inform your doctor. Be aware of and watch for signs and symptoms of hypogonadism.
When to seek medical advice
See a doctor if you or your child has any signs or symptoms of male hypogonadism. Establishing the cause of hypogonadism is an important first step to getting appropriate treatment. You or your child may require a consultation with an endocrinologist, a physician who specializes in the hormone-producing (endocrine) glands. If your primary care physician suspects the condition is present, he or she may refer you to an endocrinologist. Or, you may ask for a referral yourself.
Screening and diagnosis
Your doctor may test for decreased testosterone if you have any of the signs or symptoms of hypogonadism. Early detection in boys can help prevent delayed puberty. Early diagnosis and treatment in adult men offers better protection against osteoporosis and other related conditions.
Doctors base a diagnosis of hypogonadism on symptoms and results of blood tests that measure testosterone levels. Because testosterone levels vary and are generally highest in the morning, blood testing is usually done early in the day.
If tests confirm you have low testosterone, further laboratory testing can determine if a testicular disorder or a pituitary abnormality is the cause. Based on specific signs and symptoms, additional studies can pinpoint the cause. These studies may include hormone testing, semen analysis, pituitary imaging, genetic studies and testicular biopsy.
Testosterone testing also plays an important role in managing hypogonadism. This helps your doctor determine the right dosage of medication, both initially and over time.
The complications of untreated hypogonadism differ depending on the age of onset. If hypogonadism occurs during fetal development, a baby may be born with ambiguous genitalia. If hypogonadism develops before puberty, a lack of body hair and impaired penis and testicle growth may occur. Infertility, erectile dysfunction, decreased sex drive, fatigue, muscle loss or weakness, enlarged male breasts, decreased beard and body hair growth, and osteoporosis are possible complications of hypogonadism.
Treatment for male hypogonadism depends on the cause and if you're concerned about fertility.
For hypogonadism caused by testicular failure, doctors use male hormone replacement (testosterone replacement therapy, or TRT). Although there's often no effective treatment to restore fertility in a man with primary hypogonadism, assisted reproductive technology (ART) may be helpful. ART covers a variety of techniques designed to help couples who have been unsuccessful achieve conception.
If a pituitary problem is the cause, pituitary hormones may succeed in stimulating sperm production and restoring fertility. TRT can be used if fertility is not an issue. A pituitary tumor may require surgical removal, medication or the replacement of other hormones.
In boys, TRT can stimulate puberty and the development of secondary sex characteristics, such as increased muscle mass, beard and pubic hair growth, and growth of the penis. Pituitary hormones may be used to stimulate testicle growth. An initial low dose of testosterone with gradual increases may help to avoid adverse psychological effects.
In adult men, TRT can restore sexual function and muscle strength and prevent bone loss. In addition, men receiving TRT often experience an increase in energy, sex drive and well-being. Some anti-aging enthusiasts claim that increasing the level of testosterone in older men improves energy, well-being and sex drive, but such claims remain unproved. High doses of testosterone may result in prostate problems, elevated cholesterol and infertility. The long-term benefits or risks of TRT in healthy older men are unclear.
Several testosterone delivery methods exist. Choosing a specific therapy depends on your preference of a particular delivery system, the side effects and the cost. Methods include:
Gum and cheek (buccal cavity)
Adolescents with hypogonadism may have problems fitting in socially due to delayed sexual development. Testosterone replacement therapy can induce puberty, and at a slow pace, to allow time for adjustment to body changes and new feelings.
If hypogonadism occurs during adulthood, make lifestyle and dietary changes to prevent osteoporosis. Regular exercise and adequate amounts of calcium and vitamin D to maintain bone strength are important to reduce the risk of osteoporosis.
Men may experience psychological and relationship problems due to erectile dysfunction or infertility caused by hypogonadism. Know what to expect from these conditions and what to do if new or uncomfortable feelings develop between you and your partner. Talk with your doctor about how you can reduce the anxiety and stress that often accompany these conditions.
A supportive family that understands the diagnosis of hypogonadism is important. You may need psychological or family counseling. Support groups can help people with hypogonadism and related conditions cope with similar situations and challenges.